Clinical Characteristics and Outcomes of Influenza in Hospitalized Pediatric Patients in King Chulalongkorn Memorial Hospital

2020 ◽  
Vol 103 (11) ◽  
pp. 1220-1229
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Associated Factors ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Memorial Hospital ◽  
Molecular Testing ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease

Objective: To describe clinical characteristics and outcomes of laboratory-confirmed influenza in hospitalized children in a tertiary care center and to identify factors associated with the severity. Materials and Methods: The present study was a retrospective medical chart review study conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Data were extracted from children aged under 15 years old hospitalized between January 2014 and December 2018. Patients who had laboratory-confirmed influenza by rapid antigen detection or molecular testing were included. Severe influenza was defined as patients who developed influenza complications or duration of hospitalization for more than three days. Multivariate logistic regression was used to identify the associated factors with the severity of the disease. Results: Three hundred fifty-seven influenza patients were included with median age of 43 months (IQR 19 to 81), of which 63.3% were aged under 60 months. There were 174 patients (48.7%) with comorbidities, most common were immunosuppression (18.2%), chronic pulmonary disease (12.2%), and congenital heart disease (11.5%). Fifty-seven out of 183 patients (31.1%) had history of influenza vaccination in the medical records. One hundred sixty-one patients (45.1%) had 212 influenza complications including influenza-related pneumonia (89, 24.9%), secondary bacterial infection (53, 14.8%), and neurologic complications (47, 13.2%), in which 27 cases (7.6%) were transferred to intensive care unit (ICU). Four cases (1.1%) died but not directly related to influenza. Associated factors with complicated influenza were aged less than 24 months [aOR 2.67 (95% CI 1.68 to 4.26)] and presence of chronic lung disease [aOR 4.34 [95% CI 2.01 to 9.35)]. Conclusion: Two-third of the children hospitalized with influenza were younger than 60 months. Nearly half developed complications most associated with the age of less than two years old and patients with chronic lung disease. Low rates of vaccination were demonstrated. Keywords: Influenza, Pediatrics, Complications, Pneumonia, Hospitalization

Dendriform Pulmonary Ossification, a Form of Diffuse Pulmonary Ossification: Report of a 26-Year Autopsy Experience

2005 ◽  
Vol 129 (3) ◽  
pp. 348-353 ◽  
Author(s):  
Jonathan F. Lara ◽  
James F. Catroppo ◽  
Dae U. Kim ◽  
Delineda Costa
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Interstitial Fibrosis ◽  
Care Center ◽  
Tertiary Care ◽  
Ultrastructural Studies ◽  
Pathologic Features ◽  
Pathologic Findings ◽  
Clinical Diagnoses ◽  
History Of

Abstract Context.—Dendriform pulmonary ossification (DPO) is an uncommon form of diffuse pulmonary ossification that typically affects the pulmonary interstitium in a setting of interstitial fibrosis. Objective.—To determine the incidence and characteristics of DPO and correlate the clinical, radiographic, and pathologic features in order to better understand its pathogenesis and behavior and facilitate proper therapy. Design.—Adult autopsies performed at a tertiary care center from 1978 to 2004 were reviewed to identify cases of DPO. Clinical, radiographic, and pathologic findings, including ultrastructural studies in select cases, were analyzed and correlated. Results.—Eight cases of DPO were identified from 1393 adult autopsies. None of the cases was diagnosed antemortem. The prevalence of DPO was 0.5%, and the incidence was 0.28 cases per year. Most patients had a history of chronic lung disease, and all were 65 years of age or older. Conclusions.—Dendriform pulmonary ossification is an uncommon and unusual entity seen incidentally at autopsy and associated with chronic lung disease. It is well demonstrated in postmortem examination, confirmed by microscopy and ultrastructural study, but rarely diagnosed and virtually never considered clinically. Clinical diagnoses include bronchiectasis and interstitial pneumonitis based on radiographic evidence. With its associated radiographic/pathologic findings, DPO should be considered in the differential diagnosis of chronic lung disease.

scholarly journals 468 Clinical characteristics, etiology, and treatment of erythema multiforme at a tertiary care center

2020 ◽  
Vol 140 (7) ◽  
pp. S62
Author(s):  
G. Shi ◽  
B. Kaffenberger ◽  
Y. Semenov ◽  
J. Choi ◽  
K. Williams ◽  
...  
Keyword(s):  
Erythema Multiforme ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

scholarly journals 1696. Epidemiology, Clinical Characteristics and Outcomes of Invasive Aspergillosis in a Tertiary Care Hospital in Mexico

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S621-S621
Author(s):  
Carla Marina Román-Montes ◽  
María F Gonzalez-Lara ◽  
Alfredo Ponce de Leon ◽  
Maria O Valenzuela-Almada ◽  
Andrea Rangel-Cordero
Keyword(s):  
Liver Failure ◽  
Invasive Aspergillosis ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Solid Organ ◽  
Cell Transplant ◽  
Care Hospital ◽  
Tertiary Care Center ◽  
Eortc Criteria

Abstract Background Invasive aspergillosis is an important cause of life-threatening infection in immunocompromised patients. The objective was to describe the epidemiology, clinical characteristics, and outcome of patients with invasive aspergillosis (IA) in a tertiary care center in Mexico. Methods A laboratory-based survey was done to identify patients with positive Aspergillus culture or galactomannan from 2014 to 2018. The medical records were reviewed to include patients with proven and probable IA, according to the EORTC criteria. Descriptive analysis of clinical characteristics and risk factors for 6-week mortality was made through X2, T-test or Mann–Whitney test. A multivariate logistic regression model including variables with a P-value of <0.2 in univariate analysis was made. Results 240 cases of IA were identified: 193 (80%) probable, 27 (11%) proven, and 20 (8.3%) not meeting the EORTC criteria but considered infection. 53% were male, median age was 44 years (IQR 28–58), 78 (32.5%) had acute leukemia (AL), 42 (17.5%) hematological neoplasia, 29 (12%) hematopoietic stem-cell transplant (HSCT), 25 (10.4%) solid-organ transplant and 44 (18.3%) autoimmune diseases, 17.5% patients with AL underwent induction remission chemotherapy of which 31% received antifungal prophylaxis. Among patients with IA, 183 (82%) had a positive galactomannan and 109 (45%) had a culture with Aspergillus. Eleven had > 1 species: 55/120 (46%) were A. fumigatus, 18 (15%) A. niger and 18 (15%) A. flavus. Pulmonary disease occurred in 214 (89%). 212 patients (88%) received antifungal treatment with a median duration of 42 days (IQR 20–42). 129 (61%) received voriconazole (VRC), 20 (8.3%) Amphotericin B and 20(8.3%) were randomized to a posaconazole vs. VRC trial. Six-week mortality was 35% (n = 85). Lymphopenia (OR 3.6; 95% CI 1.4–9.0), liver failure (OR 3.3; 95% CI 1.7–6.5) and older age (OR 1.03; 95% CI 1.01–1.05) (marginally) were independently associated with increased 6-week mortality. Conclusion 240 patients with IA were identified in a 5-year period in a tertiary care center. Most had hematological neoplasias and low prevalence of antimold prophylaxis due to economical reasons. Six-week mortality was 35%, nonsurvivors had liver failure and lymphopenia more often. Increased awareness to prevent IA is needed. Disclosures All authors: No reported disclosures.

scholarly journals Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

2013 ◽  
Vol 20 (3) ◽  
pp. 162 ◽  
Author(s):  
SalihBin Salih ◽  
Huda Durihim ◽  
Hind Almodaimegh ◽  
Muhammad Yousuf ◽  
Hani Tamim
Keyword(s):  
Associated Factors ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Medical Outpatients

scholarly journals Evaluation of Exome Sequencing Criteria for Hospital Stewardship and Insurance Authorization at a Pediatric Hospital

2021 ◽  
Author(s):  
Claire L. Wittowski ◽  
Sarah Clowes Candadai ◽  
Marie E. Perrone ◽  
Daniel F. Gallego ◽  
Jessie H. Conta ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Care Center ◽  
Insurance Coverage ◽  
Genetic Diseases ◽  
Tertiary Care ◽  
Pediatric Care ◽  
Molecular Diagnostic ◽  
Molecular Testing ◽  
Coverage Criteria ◽  
Significant Difference

Context.— Genomic molecular testing practices in a pediatric tertiary care institution. Objective.— To evaluate exome sequencing (ES) ordering practices and the effects of applying criteria to support ES stewardship. Exome sequencing can provide molecular diagnostic information for patients with known or suspected genetic diseases, but it is relatively expensive, and the cost is often borne by patients, institutions, and payers. Design.— We examined ordering patterns of ES approved by board-certified geneticists at our tertiary pediatric care center, as well as preauthorization outcomes for ES requests. We compared positivity rates among patients by patient phenotype, composite insurance coverage criteria, and insurance preauthorization outcome. Results.— Patients who met composite coverage criteria were more likely to receive a positive result from ES compared to patients who did not meet composite coverage criteria, though this trend was not statistically significant. There was no significant difference in ES results between patients who were denied or not denied preauthorization by insurance payers. Conclusions.— Insurance payers should consider implementing and/or expanding coverage criteria for ES and institutions should implement stewardship programs to support appropriate ES practices.

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